Apparatus to trace and cut a tendon or other laterally extended anatomical structure

ABSTRACT

A harvesting apparatus is disclosed for harvesting anatomical structures such as tendons, fine muscles, nerves and blood vessels, where the apparatus includes an elongate member having two longitudinally extending tubes or tubular apertures extending from the member&#39;s proximal end to its distal end. The distal end includes opposing heads and an arcuate base. The anatomical structure is placed on the arcuate base and a flexible cutting member is threaded through one tube over the anatomical structure and into and through the other tube. The elongate member is then directed into an animal or human body along the structure to a position where the anatomical structure is to be cut. Then the cutting member is pulled back and forth at the distal end causing into to cut the anatomical structure at the distal head.

RELATED APPLICATIONS

This application claims priority to and the benefit of U.S. ProvisionalPatent Application Ser. No. 60/889,581 filed 13 Feb. 2007.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an apparatus for tracing and cutting alaterally extending anatomical structure in an animals body including anhuman body and to methods for making and using same.

More particularly, the present invention relates to an apparatus fortracing and cutting a laterally extending anatomical structure in ananimals body including an human body, where the apparatus includes anelongate flexible body having a proximal end, a distal end, a cuttingmember extending from the proximal end to the distal end and backthrough tubes in the flexible body terminating at two opposing aperturesin two opposing cutting guides. The apparatus is ideally suited forharvesting tendons or other laterally extending anatomical structuresfrom a surgically accessible point to a desired cutting point along thetendon or other structure within the animal or human body. The presentinvention also relates to methods for making and using same.

2. Description of the Related Art

The flexor digitorum longus (FDL) and flexor hallucis longus (FHL)tendons are used in a variety of foot reconstructive procedures. Thesetendons are generally harvested from the midfoot and transferred to adifferent location in the foot to augment or replace a degeneratedtendon.

The FDL is transferred to the navicular bone in treatment of stage IIdysfunction of the posterior tibial tendon. The FUL also is used, butless commonly for this purpose. The FHL tendon is more commonly used forAchilles tendon dysfunction caused by chronic tear or degeneration.

With the open operative technique for harvest of the FDL described byMann and Thompson in J. Bon Joint Surg. 67-A: 556-561, 1985, the FDLsheath is identified at the medial malleolus and followed distally. Theabductor hallucis muscle is retracted plantarward to expose the intervalbetween the flexor hallucis brevis and the first metatarsal. The originof the flexor hallucis brevis muscle is released to increase theexposure of the plantar aspect of the foot. The FDL tendon sheath isopened, and the tendon kept an tension, while the dissection of thesheath is carried distally into the planatar aspect of the foot. Asdissection progresses, a number of vessels have to be cauterized. TheFDL tendon is sharply divided at the most edistal extent possible. Aformal tenodesis of the FEL stump and the FHL distally is not considerednecessary because of communicating tendinous slips between the FDL andFHL. This “open” technique requires extensive, deep, and difficult,dissection in the midfoot in the vicinity of blood vessels and nerves.

To improve the success of this technique, the inventor has developed a“minimally invasive” augmented technique. The tendon sheath of the FDLor FHL is identified in the region of the hindfoot through the exposureused for the index procedure, such as exploration of the posteriortibial tendon or the Achilles tendon.

A malleable metallic probe that has a smooth bulb at its tip isintroduced within the tendon sheath and passed gently distally into themidfoot where it is easily palpated as shown in FIG. 1A. A verticalincision is then made in the skin of the midfoot over the prominencemade by the probe. Once the skin is incised, the central part of theplantar aponeurosis is exposed. The vertically oriented fibers of theaponeurosis are separated to expose muscle fibers of the flexordigitorum brevis muscle. These muscle fibers are then separated andretracted to expose the FDL tendon as shown in FIG. 1B. Because thelateral branch of the medial plantar nerve passes close to the medialborder of the flexor digitorum brevis and could be at risk, it isimportant to make the plantar incision long enough to allow adequatevisualization. The identity of the tendon is verified by pulling on thetendon through the proximal incision in the hindfoot and assessingtransmission of the tension distally to the tendon in the midfoot and atthe same time observing maximal flexion in either the lesser toes orgreater toe.

The tendon is then cut sharply in the midfoot and the cut end pulledproximally through the incision in the hindfoot as shown in FIG. 1C.

However, ever even with the augment technique, the technique involves anadditional surgical procedure in a very sensitive area of the footincreasing post operative problems. Thus, there is a need in the art foran apparatus that can be used to harvest tendon and other laterallyextending anatomical structures in an animals body including an humanbody that does not require additional surgical incisions.

SUMMARY OF THE INVENTION

The present invention provides an harvesting apparatus including anelongate flexible body. The body includes a proximal end, a distal endand a flexible cutting member. The body include two hollow tubularmembers extending a length of the body from the proximal end to thedistal end. The tubular members run parallel down the length of the bodyfrom the proximal end to a point near the distal end. In one embodiment,the distal end includes two opposing cutting guide heads having opposingcutting channels. The distal end also includes an arcuate base betweenthe two heads adapted to receive an anatomical structure. The cuttingmember is adapted to be threaded into one tubular aperture at theproximal end of the body until it exits through its cutting guide headso that the cutting member is positioned above or rests adjacent a topsurface of the structure to be cut. In another embodiment, the distalend includes two opposing cutting guide heads defining a slot forreceiving an anatomical structure. The distal end is generally flat, butwhen a anatomical structure is inserted into the distal end, the distalend flexes up. This tension provides the downward force for cuttingthrough the anatomical structure so that the distal end will relax toits generally flat configuration.

The cutting member is then threaded through the other tubular apertureuntil it exits the other tubular aperture at the proximal end of thebody. The threading can be performed prior to positioning the structurein the distal end or after positioning the structure in the distal end.The distal end of the apparatus is then pushed or slid along thestructure until the distal end is positioned at a location along thestructure, where the structure is to be cut. By alternately pulling onthe cutting member ends, the cutting member will follow the channel andcut the structure section positioned between the two cutting guideheads. In certain embodiments, the channels are angled so that a top ofthe channel is more distal than a bottom of the channel to increasecutting efficiency. In certain embodiments, a top surface of the body ofthe apparatus is curved to engage and aid the apparatus body infollowing the anatomical structure to be point where the structure is tobe cut. The apparatus is ideally suited for harvesting tendons or otherlaterally extending anatomical structures from a surgically accessiblepoint to a desired cutting point along the tendon within the animal orhuman body. In those embodiments, where the distal end does not includecutting channels, but cuts due to a force to attain a flat contour andthe end expands to allow the anatomical structure to be cut, the backand forth motion of the cutting member cuts through the structure.

The present invention also provides an harvesting apparatus including anelongate flexible body. The body includes a proximal end, a distal end,a flexible cutting member, and a flexible, bio-erodible orbio-degradable suturing member. The body include three tubular aperturesextending a length of the body from the proximal end to the distal end.The tubular apertures run parallel down the length of the body from theproximal end to a point near the distal end. The distal end includes asuturing station and a cutting station. The suturing station includestwo opposing suturing heads, an arcuate suturing base between thesuturing heads and a suture guide channel extending from the suturingheads to the heads, where the base is adapted to receive an anatomicalstructure so that the suturing member loops around the structure. Thesuturing member is designed to be threaded through the tubular apertureleading to the suturing station and fitted into the suture guide channeland across a top surface of the anatomical structure. The suture memberis then tied of at the other head with a slip knot so that when thesuturing member is pulled at the proximal end of the apparatus, the loopwill tighten on the structure sealing the structure at the suturingstation. The cutting station includes two opposing cutting guide headshaving opposing cutting channels. The cutting station also includes anarcuate base between the two heads adapted to receive the anatomicalstructure so that the cutting member is positioned above and restsadjacent a top surface of the structure. The cutting member is adaptedto be threaded into one tubular aperture at the proximal end of the bodyuntil it exits through its cutting guide head. The cutting member isthen threaded into and through the other tubular aperture until is exitsthe other tubular aperture at the proximal end of the body. Byalternately pulling on the cutting member ends, the cutting member willfollow the channel and cut the structure portion positioned between thetwo cutting guide heads proximate the sutured portion of the structure.In certain embodiments, the channels are angled so that a top of thechannel is more distal than a bottom of the channel to increase cuttingefficiency. In certain embodiments, a top surface of the body of theapparatus is curved to engage and aid the apparatus body in followingthe anatomical structure to be point where the structure is to be cut.The apparatus is ideally suited for harvesting blood vessels or othertubular structures from a surgically accessible point to a desiredcutting point along the tendon within the animal or human body.

Any of the above embodiments can also include fiber optic systems forlight and viewing the positioning of the distal end of the apparatus.The distal end of the apparatus can also include X-ray opaque elementsfor X-ray monitoring of distal end positioning. The distal end of theapparatus can also include monitors for monitoring an environmentsurround in the distal end. The distal end can also include ultrasoundreflective elements for ultrasound monitoring of distal end position.

The present invention provides a method for harvesting a laterallyextending anatomical structure of an animal including a human. Themethod includes the step of making an incision in the animal or human ata readily or convenient location to expose the anatomical structure tobe harvested. The distal end of an apparatus of this invention is thenpositioned so that the structure rests on the arcuate base between thecutting head or on the two arcuate bases of the suturing station and thecutting station. Once the distal end is properly positioned on thestructure, the cutting member is inserted into one of the tubularapertures and threaded through the aperture until it exits at one of thecutting heads. The cutting member is then passed over the structure andinto the other tubular aperture at the opposing cutting head andthreaded through the tubular aperture until it exits the tubularaperture at the proximal end of the apparatus. The distal end ofapparatus is then forced along the structure from the incision to aposition along the structure in the animal or human, where the structureis to be cut. The cutting member is then pulled from one end and thenfrom the other end causing the cutting member to cut into and throughthe structure at the distal end. After the structure is severed at thedistal end, the apparatus is withdrawn along with the cut structure.

The present invention provides a method for harvesting a laterallyextending anatomical structure of an animal including a human. Themethod includes the step of making an incision in the animal or human ata readily or convenient location to expose the anatomical structure tobe harvested. The distal end of an apparatus of this invention is thenpositioned so that the structure rests on the arcuate base between thecutting head or on the two arcuate bases of the suturing station and thecutting station. Once the distal end is properly positioned on thestructure, then for those apparatuses with suturing stations, thesuturing member is inserted into the suturing tubular aperture until thesuturing member exits the end of the suturing tubular aperture at thesuturing station. The suturing member is then threaded through thesuturing channel until is loops around the structure. A slip knot isthen formed in the suturing member and the knot forced into the suturingchannel so that it remains there until the suturing member is pulled atthe proximal end of the apparatus causing the loop to tighten around thestructure and sealing the structure at the suturing station. The cuttingmember is inserted into one of the tubular apertures and threadedthrough the aperture until it exits at one of the cutting heads. Thecutting member is then passed over the structure and into the othertubular aperture at the opposing cutting head and threaded through thetubular aperture until it exits the tubular aperture at the proximal endof the apparatus. The distal end of apparatus is then forced along thestructure from the incision to a position along the structure in theanimal or human, where the structure is to be suture and cut. Thesuturing member is then pulled to suture the structure at the suturingstation. Once the structure has been sutured, the cutting member is thenpulled from one end and then from the other end causing the cuttingmember to cut into and through the structure at the distal end. Afterthe structure is severed at the distal end, the apparatus is withdrawnalong with the cut structure.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention can be better understood with reference to the followingdetailed description together with the appended illustrative drawings inwhich like elements are numbered the same:

FIGS. 1A-C depict photographs of a prior art instrument and method forextracting a tendon for transplantation.

FIGS. 2A-C depict different views of an embodiment of a harvestingapparatus of this invention including a cutting distal end.

FIGS. 3A-D depict a cutting process of an anatomical structurepositioned in a distal end of an apparatus of this invention.

FIG. 4 depicts another embodiment of a harvesting apparatus of thisinvention including a suturing station and cutting station at the distalend of the apparatus.

FIGS. 5A-E depict another embodiment of harvesting apparatus of thisinvention and a cutting process of an anatomical structure positioned ina distal end of the apparatus.

DETAILED DESCRIPTION OF THE INVENTION

The inventors have found that an apparatus can be constructed to harvestanatomical structures such as tendons, slender muscles, long nervefilaments or bundles, blood vessels, or other laterally extendedanatomical structures. The apparatus includes an elongate body havingproximal end and a distal end. The distal end includes two opposingcutting guides and an arcuate base adapted to partially surround ananatomical structure position with the base. The apparatus includes aflexible cutting member adapted to be threaded through two tubularapertures, each extending from the proximal end to each of the cuttingguides of the distal end. When the cutting member is threaded throughthe tubular members, a portion of the cutting member will rest on a topsurface of a portion of the anatomical structure. Once the distal end ispositioned at a point on the structure where the structure will be cut,cutting can commence. By alternatively pulling the ends of the cuttingmember, the member will follow guide channels in the guide heads and cutthrough the tendon. In certain embodiments, the cutting guides areangled so that when the cutting member is at the top of the guidechannels it is farther from the proximal end and closer at the bottom ofthe guides channels. The angle is generally between about 5° and about75° from the vertical (taken as 0° here). In other embodiments, thedistal end assembly does not include channels, but the distal endassembly prefers to be generally flat, but when the structure isinserted into the distal end assembly, the assembly is flexed. Thedownward pressure on the structure provides the force that permits thecutting member to cut the structure.

The invention broadly relates to an apparatus including an elongatemember including a proximal end and a distal end. The apparatus alsoinclude a flexible cutting member in the form of a string or wire. Theelongate member includes two tubular apertures extending from theproximal end of the apparatus to a location in the distal end. Thedistal end include two opposing cutting guide heads and an arcuate baseextending between or interposed between the opposing cutting heads. Thetubular apertures terminate at a base of cutting grooves that extend toa top location of the cutting heads so that when an anatomical structureis properly position in the arcuate base of the distal end, the cuttingmember extends across a gap between the cutting heads proximate a top ofthe structure or resting on the top of the structure. The cutting memberis adapted to be inserted into one of the tubular aperture at theproximal end of the apparatus and threaded through the aperture until itexits at the base of its groove. The cutting member is then passed upover the structure along the grooves and into the other tubularaperture. The cutting member is then threaded through the secondaperture and out of the proximal end of the apparatus. The distal end ofthe apparatus is then forced along the structure until the distal end isproperly positioned at a location to be cut. Once properly positioned,the structure is cut pulling alternate ends of the cutting member backand forth cutting the structure. The cutting member can flow along guidechannels in the distal end.

The present invention also relates to an harvesting apparatus comprisingan elongate flexible body including a proximal end, a distal end, twohollow tubular members extending a length of the body and having twoopposing distal cutting guide heads disposed at the distal end of thebody and two proximal openings disposed at or near the proximal end ofthe body. The apparatus also comprises a flexible cutting member adaptedto be threaded into one tubular member through its proximal opening,through the tubular member, out its guide head, into the other tubularmember through its guide head, through the other tubular member, and outit its proximal opening. The distal end is adapted to receive ananatomical structure and a back and forth motion of the cutting memberresults in severing of the anatomical structure. In certain embodiments,the tubular members further having opposing cutting channels. In otherembodiments, the tubular members further having an arcuate base betweenthe two heads adapted to receive an anatomical structure. In otherembodiments, the channels are angled so that a top of the channel ismore distal than a bottom of the channel to increase cutting efficiency.In certain embodiments, a top surface of the body of the apparatus iscurved to engage and aid the apparatus body in following the anatomicalstructure to be point where the structure is to be cut. In otherembodiments, the proximal end of the body comprises a handle. Theanatomical structures is a tendon, a slender muscle, a long nervefilament or bundle, a vessel, or other laterally extended anatomicalstructures. In any of the embodiments of this paragraph, the heapparatus may also comprise an fiber optic system for viewing thepositioning of the distal end of the apparatus, an X-ray opaque elementsfor X-ray monitoring of distal end positioning, an ultrasound reflectiveelements for ultrasound monitoring of distal end position, or a monitorfor monitoring an environment surround in the distal end.

The present invention also relates to an harvesting apparatus comprisingan elongate flexible body. The elongate body includes three tubularmembers extending a length of the body, each member two proximalopenings. The elongate body also includes a distal end comprising asuturing station. The suturing station comprises two opposing suturingheads, a suture guide channel extending from the suturing heads, and anarcuate suturing base between the suturing heads, where the base isadapted to receive an anatomical structure so that the suturing memberloops around the structure, where the suturing member is designed to bethreaded through the tubular aperture leading to the suturing stationand fitted into the suture guide channel and across a top surface of theanatomical structure. The elongate body also includes a cutting stationcomprising two opposing distal cutting guide heads. The he distal end ofthe body is adapted to receive an anatomical structure and a back andforth motion of the cutting member results in severing of the anatomicalstructure. The apparatus also includes a flexible cutting member adaptedto be threaded into one of the three tubular members through itsproximal opening, through the tubular member, out its guide head, into asecond of the three tubular member through its guide head, through thesecond tubular member, and out it its proximal opening. The apparatusalso includes a flexible, bio-erodible or bio-degradable suturing memberis thread through the third tubular member forming a loop at thesuturing station and tied of at one of the suturing heads with a slipknot so that when the suturing member is pulled at its proximal endextending out of the proximal opening of the third tubular member, theloop will tighten on the anatomical structure suturing the structure atthe suturing station. In certain embodiments. the cutting stationfurther comprising opposing cutting channels. In other embodiments, thecutting station further comprising an arcuate base between the two headsadapted to receive an anatomical structure. In other embodiments, thechannels are angled so that a top of the channel is more distal than abottom of the channel to increase cutting efficiency. In otherembodiments, a top surface of the body of the apparatus is curved toengage and aid the apparatus body in following the anatomical structureto be point where the structure is to be cut. In other embodiments, theproximal end of the body comprises a handle. In other embodiments, theanatomical structures is a tendon, a slender muscle, a long nervefilament or bundle, a vessel, or other laterally extended anatomicalstructures. In any of the embodiments of this paragraph, the heapparatus may also comprise an fiber optic system for viewing thepositioning of the distal end of the apparatus, an X-ray opaque elementsfor X-ray monitoring of distal end positioning, an ultrasound reflectiveelements for ultrasound monitoring of distal end position, or a monitorfor monitoring an environment surround in the distal end.

The present invention also relates to a method for harvesting alaterally extending anatomical structure of an animal including a human,the method comprising the step of making an incision in the animal orhuman at a readily or convenient location to expose an anatomicalstructure to be harvested. After the incision is made, a distal end ofan apparatus is positioned adjacent a site of the anatomical structure.The apparatus comprises an elongate flexible body including a proximalend, the distal end, and two hollow tubular members extending a lengthof the body and having two opposing distal cutting guide heads disposedat the distal end of the body and two proximal openings disposed at ornear the proximal end of the body. The apparatus also comprises aflexible cutting member, where the distal end is adapted to receive ananatomical structure and a back and forth motion of the cutting memberresults in severing of the anatomical structure. Next, threading thecutting member into one tubular member through its proximal opening,through the tubular member, out its guide head, into the other tubularmember through its guide head, through the other tubular member, and outit its proximal opening so that a portion of the cutting member isdisposed on a top surface of the anatomical structure. Next, sliding theapparatus down the anatomical structure to a position at which thestructure is to be cut. Next, pulling ends of the cutting member backand forth to cut into and through the anatomical structure at theposition. Lastly, removing the apparatus and the anatomical structure.

The present invention also relates to a method for harvesting alaterally extending anatomical structure of an animal including a human,the method comprising the step of making an incision in the animal orhuman at a readily or convenient location to expose an anatomicalstructure to be harvested. After the incision is made, a distal end ofan apparatus is positioned adjacent a site of the anatomical structure.The apparatus comprises an elongate flexible body including threetubular members extending a length of the body, each member two proximalopenings. The body also includes the distal end comprising a suturingstation. The suturing station comprises two opposing suturing heads, asuture guide channel extending from the suturing heads, and an arcuatesuturing base between the suturing heads, where the base is adapted toreceive an anatomical structure so that the suturing member loops aroundthe structure, where the suturing member is designed to be threadedthrough the tubular aperture leading to the suturing station and fittedinto the suture guide channel and across a top surface of the anatomicalstructure. The body also includes a cutting station comprising twoopposing distal cutting guide heads. The distal end is adapted toreceive an anatomical structure and a back and forth motion of thecutting member results in severing of the anatomical structure. Theapparatus also includes a flexible cutting member and a flexible,bio-erodible or bio-degradable suturing member is thread through thethird tubular member forming a loop at the suturing station and tied ofat one of the suturing heads with a slip knot. Next, threading thecutting member into one tubular member through its proximal opening,through the tubular member, out its guide head, into the other tubularmember through its guide head, through the other tubular member, and outit its proximal opening so that a portion of the cutting member isdisposed on a top surface of the anatomical structure. Next, sliding theapparatus down the anatomical structure to a position at which thestructure is to be cut. Next, pulling ends of the cutting member backand forth to cut into and through the anatomical structure at theposition. Next, pulling the suturing member at its proximal endextending out of the proximal opening of the third tubular member sothat the loop tightens on the anatomical structure suturing thestructure at the suturing station. Lastly, removing the apparatus andthe anatomical structure.

Suitable material out of which the apparatus of this invention can bemade includes, without limitation, any flexible material that isapproved for use in an animal or human body. Moreover, the handle partof the apparatus can be inflexible or less flexible than the tubularmembers. Exemplary examples of materials include plastics, rubbers,metals or combinations of these materials provided that the material isapproved for use in animals or humans.

Suitable material out of which the cutting member of this invention canbe made includes, without limitation, any high tensile strength materialthat can be made into a wire or continuous filament. Exemplary examplesof such materials include metallic wires, synthetic or natural fibrousmaterials commonly used in medicine. The wires or filaments can besmooth or rough or textured to improve cutting efficiency. The wires orfilaments can be differentially textures so that the portion of the wireor filament that will cut the anatomical structure (e.g., tendon,muscle, nerve, vessel, etc.).

Suitable material out of which the suturing member of this invention canbe made includes, without limitation, any suturing material now known orwill be invented in the future. Exemplary examples of such materialsinclude natural sutures made of collagen from intestines of mammals orfrom synthetic collagen (polymers) or other synthetic polymers that havebeen approved by the FDA for use in animals including humans.

Referring now to FIGS. 2A-C, an embodiment of an apparatus of thisinvention, generally 200 is shown to include an elongate member 202having a proximal end 204 and a distal end 206. The elongate member 202includes two tubular apertures 208 a& b extending from the proximal end204 to the distal end 206. The proximal end 204 can also include two legsections (shown in the attachment) having feet, where the two tubularaperture terminate. The distal end 206 include two opposing heads 210 a&b and an arcuate base 212 interposed therebetween. The heads 210 a& binclude cutting guide channels 214 a& b having bases 216 a& b coincidentwith the distal ends of the tubular apertures 208 a& b. The apparatus200 also includes a flexible cutting member 218, which passes throughthe tubular apertures 208 a from the proximal end 204 of the apparatus100 to the base 216 a. The member 218 then follows the guide channel 214a, then across a gap 220 between the head 210 a and 210 b. The member218 then follows the channel 214 b into the base 216 b, through theaperture 208 b and out the proximal end 204 of the apparatus. Looking atFIG. 2B, the member 202 can have a concave top surface 222 and a conveybottom surface 224 adapted to engage an anatomical structure.

Referring now to FIGS. 3A-D, the apparatus 200 of FIGS. 2A-C is shown ina series of views of the apparatus 200 cutting through an anatomicalstructure 226.

Referring now to FIG. 4, another embodiment of an apparatus of thisinvention, generally 400 is shown to include an elongate member 402having a proximal end 404 and a distal end 406. The elongate member 402includes three tubular apertures 408 a-c extending from the proximal end404 to the distal end 406. The proximal end 404 can also include two legsections (shown in the attachment) having feet, where the two tubularaperture terminate. The distal end 406 include a suturing station 410and a cutting station 412. The suturing station 410 include two opposingsuturing station heads 414 a& b and an arcuate base 416 interposedtherebetween. The suturing station heads 414 a& b include suturing guidechannels 418 a& b having a base 420 coincident with the distal end ofthe tubular aperture 408 c. The cutting station 412 includes twoopposing cutting station heads 422 a& b and an arcuate base 424interposed therebetween. The cutting station heads 422 a& b includecutting guide channels 426 a& b having bases 428 a& b coincident withthe distal ends of the tubular apertures 408 a& b. The apparatus 400also includes a flexible cutting member 430, which passes through thetubular apertures 408 a from the proximal end 404 of the apparatus 400to the base 428 a. The cutting member 440 then follows the guide channel426 a, then across a gap 432 between the head 422 a and 422 b. Thecutting member 440 then follows the channel 426 b into the base 428 b,through the aperture 408 b and out the proximal end 404 of theapparatus. The apparatus 400 also includes a flexible suturing member434, which passes through the tubular aperture 408 c from the proximalend 404 of the apparatus 400 to the base 420. The suturing member 444then follows the guide channel 418 a, then across a gap 436 between thehead 414 a and 414 b. The suturing member 444 then follows the channel418 b past the base 420 and a slip knot 438 is formed and pushed intothe channel 418 a. The suturing member 444 is designed to be pulled sothat the loop formed by the slip knot 438 tightens about an anatomicalstructure to suture the structure above the position where it will becut.

Referring now to FIGS. 5A-E, another embodiment of an apparatus of thisinvention, generally 500, is shown to include an elongate member 502having a distal end 504 and a proximal end 506 comprising a handle 508.The elongate member 502 also includes two hollow tubular members 510 a&b. The tubular members 510 a& b include proximal end portions 512 a& band distal end portions 514 a& b. The proximal end portions 512 a& binclude flared openings 516 a& b, and similarly, the distal ends 514 a&b include flared openings 518 a& b. The two flared openings 518 a& bface each other, while the two flared openings 516 a& b point away fromeach other.

Looking at FIG. 5B, a cutting member 520 is designed to be threaded intothe opening 516 a or 516 b, through the tubular member 510 a or 510 b,out of the distal end opening 518 a or 518 b, into the distal endopening 518 b or 518 a, through the tubular member 510 b or 510 a andout the proximal end opening 516 b or 516 a, respectively. In this way,the cutting member 520 is disposed across the distal ends 514 a& b ofthe tubular member 510 a& b. The

Looking at FIG. 5C, the distal 504, with the cutting member 520, is slidonto a tendon 522 so that the tendon 522 is inside a cutting zone 524 ofthe apparatus 500 defined by the curved distal ends 512 a& b of thetubular members 508 a& b.

Looking at FIG. 5D, the apparatus 500, with the assistance of the handle506, is slid down the tendon 520 to a desired location.

Looking at FIG. 5E, the cutting member 520 is then pulled back and forthto cut the tendon 522 at the location within the cutting zone 524. Thedistal end portions 514 a& b of the tubular members 510 a& b areflexible so that the end portions 514 a& b can separate further duringthe tendon cutting process. Cutting is achieved because the cutting zone524 is design to be flat so that it is forced to

Alternatively, the apparatus 500 can be slid down a tendon and once thecutting location along the tendon is located, the cutting member 520 canbe threaded through the tubular member 510 a& b. With the cutting member520 in place, the tendon can then be cut as shown in FIG. 5E. Although agap 526 is shown between the flared distal openings 516 a& b, the gapcan be really small so that the cutting member 520 can be threadedthrough the tubular members 510 a& b without an opportunity for thecutting member 520 to miss the facing opening.

All references cited herein are incorporated by reference. Although theinvention has been disclosed with reference to its preferredembodiments, from reading this description those of skill in the art mayappreciate changes and modification that may be made which do not departfrom the scope and spirit of the invention as described above andclaimed hereafter.

1. An harvesting apparatus comprising: an elongate flexible bodyincluding: a proximal end, a distal end, two hollow tubular membersextending a length of the body and having two opposing distal cuttingguide heads disposed at the distal end of the body and two proximalopenings disposed at or near the proximal end of the body, and aflexible cutting member adapted to be threaded into one tubular memberthrough its proximal opening, through the tubular member, out its guidehead, into the other tubular member through its guide head, through theother tubular member, and out it its proximal opening, where the distalend is adapted to receive an anatomical structure and a back and forthmotion of the cutting member results in severing of the anatomicalstructure.
 2. The apparatus of claim 1, wherein the tubular membersfurther having opposing cutting channels.
 3. The apparatus of claim 1,wherein the tubular members further having an arcuate base between thetwo heads adapted to receive an anatomical structure.
 4. The apparatusof claim 2, wherein the channels are angled so that a top of the channelis more distal than a bottom of the channel to increase cuttingefficiency.
 5. The apparatus of claim 1, wherein a top surface of thebody of the apparatus is curved to engage and aid the apparatus body infollowing the anatomical structure to be point where the structure is tobe cut.
 6. The apparatus of claim 1, wherein the proximal end of thebody comprises a handle.
 7. The apparatus of claim 1, wherein theanatomical structures is a tendon, a slender muscle, a long nervefilament or bundle, a vessel, or other laterally extended anatomicalstructures.
 8. The apparatus of claim 1, further comprising: an fiberoptic system for viewing the positioning of the distal end of theapparatus, an X-ray opaque elements for X-ray monitoring of distal endpositioning, an ultrasound reflective elements for ultrasound monitoringof distal end position, or a monitor for monitoring an environmentsurround in the distal end.
 9. An harvesting apparatus comprising: anelongate flexible body including: three tubular members extending alength of the body, each member two proximal openings, a distal endcomprising: a suturing station comprising: two opposing suturing heads,a suture guide channel extending from the suturing heads, and an arcuatesuturing base between the suturing heads, where the base is adapted toreceive an anatomical structure so that the suturing member loops aroundthe structure, where the suturing member is designed to be threadedthrough the tubular aperture leading to the suturing station and fittedinto the suture guide channel and across a top surface of the anatomicalstructure, a cutting station comprising: two opposing distal cuttingguide heads, and where the distal end is adapted to receive ananatomical structure and a back and forth motion of the cutting memberresults in severing of the anatomical structure, a flexible cuttingmember adapted to be threaded into one of the three tubular membersthrough its proximal opening, through the tubular member, out its guidehead, into a second of the three tubular member through its guide head,through the second tubular member, and out it its proximal opening, anda flexible, bio-erodible or biodegradable suturing member is threadthrough the third tubular member forming a loop at the suturing stationand tied of at one of the suturing heads with a slip knot so that whenthe suturing member is pulled at its proximal end extending out of theproximal opening of the third tubular member, the loop will tighten onthe anatomical structure suturing the structure at the suturing station.10. The apparatus of claim 9, wherein the cutting station furthercomprising opposing cutting channels.
 11. The apparatus of claim 9,wherein the cutting station further comprising an arcuate base betweenthe two heads adapted to receive an anatomical structure.
 12. Theapparatus of claim 10, wherein the channels are angled so that a top ofthe channel is more distal than a bottom of the channel to increasecutting efficiency.
 13. The apparatus of claim 9, wherein a top surfaceof the body of the apparatus is curved to engage and aid the apparatusbody in following the anatomical structure to be point where thestructure is to be cut.
 14. The apparatus of claim 9, wherein theproximal end of the body comprises a handle.
 15. The apparatus of claim9, wherein the anatomical structures is a tendon, a slender muscle, along nerve filament or bundle, a vessel, or other laterally extendedanatomical structures.
 16. The apparatus of claim 9, further comprising:an fiber optic system for viewing the positioning of the distal end ofthe apparatus, an X-ray opaque elements for X-ray monitoring of distalend positioning, an ultrasound reflective elements for ultrasoundmonitoring of distal end position, or a monitor for monitoring anenvironment surround in the distal end.
 17. A method for harvesting alaterally extending anatomical structure of an animal including a human,the method comprising the steps of: making an incision in the animal orhuman at a readily or convenient location to expose an anatomicalstructure to be harvested; positioning a distal end of an apparatusadjacent a site of the anatomical structure, where the apparatuscomprises: an elongate flexible body including: a proximal end, thedistal end, two hollow tubular members extending a length of the bodyand having two opposing distal cutting guide heads disposed at thedistal end of the body and two proximal openings disposed at or near theproximal end of the body, a flexible cutting member, where the distalend is adapted to receive an anatomical structure and a back and forthmotion of the cutting member results in severing of the anatomicalstructure threading the cutting member into one tubular member throughits proximal opening, through the tubular member, out its guide head,into the other tubular member through its guide head, through the othertubular member, and out it its proximal opening so that a portion of thecutting member is disposed on a top surface of the anatomical structure,sliding the apparatus down the anatomical structure to a position atwhich the structure is to be cut, pulling ends of the cutting memberback and forth to cut into and through the anatomical structure at theposition, and removing the apparatus and the anatomical structure.
 18. Amethod for harvesting a laterally extending anatomical structure of ananimal including a human, the method comprising the steps of: making anincision in the animal or human at a readily or convenient location toexpose an anatomical structure to be harvested; positioning a distal endof an apparatus adjacent a site of the anatomical structure, where theapparatus comprises: an elongate flexible body including: three tubularmembers extending a length of the body, each member two proximalopenings, the distal end comprising: a suturing station comprising  twoopposing suturing heads,  a suture guide channel extending from thesuturing heads, and an arcuate suturing base between the suturing heads,where the base is adapted to receive an anatomical structure so that thesuturing member loops around the structure,  where the suturing memberis designed to be threaded through the tubular aperture leading to thesuturing station and fitted into the suture guide channel and across atop surface of the anatomical structure, a cutting station comprising: two opposing distal cutting guide heads, and where the distal end isadapted to receive an anatomical structure and a back and forth motionof the cutting member results in severing of the anatomical structure, aflexible cutting member adapted to be threaded into one of the threetubular members through its proximal opening, through the tubularmember, out its guide head, into a second of the three tubular memberthrough its guide head, through the second tubular member, and out itits proximal opening, and a flexible, bio-erodible or bio-degradablesuturing member is thread through the third tubular member forming aloop at the suturing station and tied of at one of the suturing headswith a slip knot, threading the cutting member into one tubular memberthrough its proximal opening, through the tubular member, out its guidehead, into the other tubular member through its guide head, through theother tubular member, and out it its proximal opening so that a portionof the cutting member is disposed on a top surface of the anatomicalstructure, sliding the apparatus down the anatomical structure to aposition at which the structure is to be cut, pulling ends of thecutting member back and forth to cut into and through the anatomicalstructure at the position; pulling the suturing member at its proximalend extending out of the proximal opening of the third tubular member sothat the loop tightens on the anatomical structure suturing thestructure at the suturing station, and removing the apparatus and theanatomical structure.